A CASE REPORT ON DIGOXIN INTOXICATION IN A CLINICAL PHARMACIST’S PERSPECTIVE

Context: Digoxin is a commonly used inotropic drug that has a narrow therapeutic range and is monitored poorly for its plasma concentration. It is commonly used in the management of cardiovascular disorders for its inotropic effects. Increased risk of chronic digoxin toxicity among the patients receiving digoxin pharmacotherapy is related to its narrow therapeutic range. Apart from its inotropic properties, it can also produce chronotropic and dromotropic effect. Its serum levels vary due to changes in body weight, age, renal function, hepatic impairment, and concomitant drug administrations. Patients receiving digoxin should be monitored periodically for potential drug interactions, adverse effects, toxicity, and other drug-related problems. Symptoms of digoxin-induced cardiotoxicity are difficult to be identified and may become fatal too. Therapeutic drug monitoring will play a significant role in reducing such drug therapy problems and will ensure safety and efficacy of the given drug. Case Report: We report a case of chronic digoxin toxicity in a 22-year-old male with congestive cardiac failure - Class IV and atrial fibrillation with ventricular bigeminy. Results: Patient’s renal parameters were elevated and among electrolytes, sodium level was decreased and potassium level was increased. A reduction in the volume of the distribution of digoxin, due to impairment of renal function or congestive cardiac failure, might be one of the reasons for digoxin toxicity. Drug therapy problems (DTPs) such as untreated indication, inappropriate drug therapy, potential major drug-drug interactions, and drugs prescribed when contraindicated were observed. Conclusion: Monitoring digoxin drug therapy can bring down the risk of digoxin intoxication.

Electrocardiographic Changes After Suicidal Digoxin Intoxication in a Healthy Woman

Background: Suicidal digoxin intoxication is a rare clinical entity. Clinical suspicious remains of paramount importance as adequate interpretation of the electrocardiographic changes enable to readily initiate treatment. Method: We describe a case of suicidal attempt after massive digoxin intake that was satisfactory managed with conservative management strategy that involved a close clinical surveillance of the evolving electrocardiographic changes and digoxin serum levels.

Bidirectional Tachycardia after an Acute Intravenous Administration of Digitalis for a Suicidal Gesture

Acute digoxin intoxication is a life-threating condition associated with severe cardiotoxicity. Female gender, age, low lean body mass, hypertension, and renal insufficiency may worsen the prognosis. Arrhythmias caused by digitalis glycosides are characterized by an increased automaticity coupled with concomitant conduction delay. Bidirectional tachycardia is pathognomonic of digoxin intoxication, but it is rarely observed. An 83-year-old woman was admitted to the Emergency Department after self-administration of 5 mg of digoxin i.v. for suicidal purpose. Her digoxin serum concentration was 17.4 ng/mL. The patient developed a bidirectional tachycardia and the Poison Control Center of the hospital provided digoxin immune fab. Bidirectional tachycardia quickly reversed and the patient remained stable throughout the hospital stay. This case shows that a multiple disciplinary approach, involving cardiologists and toxicologists, is essential for the management of digoxin intoxication. The optimal treatment of this rare event depends on the clinical conditions and on the serum drug concentration of the patient. Digoxin immune fab represents a safe, effective, and specific method for rapidly reversing digitalis cardiotoxicity and should be started as soon as the diagnosis is defined.